tag:theconversation.com,2011:/us/topics/dissociative-identity-disorder-44284/articlesdissociative identity disorder – The Conversation2019-07-24T05:05:24Ztag:theconversation.com,2011:article/1167312019-07-24T05:05:24Z2019-07-24T05:05:24ZDissociative disorders are nearly as common as depression. So why haven’t we heard about them?<figure><img src="https://images.theconversation.com/files/283635/original/file-20190711-173329-ayfx80.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some people feel so disconnected, they don't even recognise themselves in the mirror.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/reflection-stressed-woman-holding-her-head-651547174?src=jpM5GgtwUMRKd3nVisHdwA-1-77&studio=1">from www.shutterstock.com</a></span></figcaption></figure><p>Dissociative disorders are often said to be <a href="http://www.teachtrauma.com/controversial-topics-trauma/myths-media-portrayals-dissociative-identity-disorder/">rare</a>. But our soon-to-be published analysis of <a href="https://www.researchgate.net/publication/334625332">international studies</a> suggest they affect 10-11% of the population at some point in their lives. This makes them nearly as common as <a href="https://journals.sagepub.com/doi/abs/10.1177/070674370404900208">mood disorders</a> (such as clinical depression).</p>
<p>So what are dissociative disorders, why is diagnosis controversial and how can people be treated?</p>
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Read more:
<a href="https://theconversation.com/mood-and-personality-disorders-are-often-misconceived-heres-what-you-need-to-know-94971">Mood and personality disorders are often misconceived: here's what you need to know</a>
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<h2>What is dissociation?</h2>
<p>Dissociation occurs when a person experiences being disconnected from themselves, including their memories, feelings, actions, thoughts, body and even their identity. </p>
<p>People with dissociative disorders have one or more of the following <a href="https://psycnet.apa.org/record/1995-98841-000">symptoms</a>:</p>
<ul>
<li>amnesia and other memory problems</li>
<li>a sense of detachment or disconnection from their self, familiar people or surroundings</li>
<li>an inner struggle about their sense of self and identity</li>
<li>acting like a different person (identity alteration).</li>
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<p>For some people, symptoms can last days or weeks, but for others they can persist for months, years, or a lifetime. </p>
<p>Dissociation allows the person to compartmentalise and disconnect from aspects of traumatic and challenging experiences that could otherwise overwhelm their capacity to cope. </p>
<p>A person whose spouse has died may become emotionally numb, allowing them to focus on arranging the funeral; a man who has separated from his wife and lost his job soon afterwards may become so disconnected from his identity that he no longer recognises himself in the mirror and feels his life is happening to someone else; and a young woman who is sexually assaulted may remember her attacker moving too quickly towards her, recalls being safely back in her family home, but cannot remember the assault.</p>
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<p>If the traumatic and overwhelming experiences happen repeatedly over a long period of time, the person’s <a href="https://books.wwnorton.com/books/detail.aspx?id=9227">personality may become fragmented</a>. The traumatised part of the personality that contains the emotions, thoughts, sensations and experiences relating to the trauma becomes separated from the part of the personality that is trying to get on with daily life.</p>
<p>This <a href="http://www.hup.harvard.edu/catalog.php?isbn=9780674068063&content=reviews">allows young children to be with frightening and abusive caregivers</a> they can neither fight nor flee from as they are dependent on them.</p>
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Read more:
<a href="https://theconversation.com/dissociative-identity-disorder-exists-and-is-the-result-of-childhood-trauma-85076">Dissociative identity disorder exists and is the result of childhood trauma</a>
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<p>The person may have no (or only some) conscious awareness of the compartmentalised memories, thoughts, feelings and experiences. </p>
<p>These may, however, intrude into the person’s awareness. For example, the person may be aware of thoughts, feelings and internal voices that don’t “belong” to them, or may speak or act in ways that are completely out of character.</p>
<p>The most extreme form of structural dissociation is <a href="https://theconversation.com/dissociative-identity-disorder-exists-and-is-the-result-of-childhood-trauma-85076">dissociative identity disorder</a>, once known as multiple personality disorder. This is where the person has at least two separate personalities that exist independently of one another and that emerge at different times.</p>
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<figcaption><span class="caption">Australian actor Toni Collette plays Tara, who has dissociative identity disorder, in the US comedy The United States of Tara. But most dissociative disorders are far less extreme.</span></figcaption>
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<p>These personality differences are not just psychological. <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/aiding-the-diagnosis-of-dissociative-identity-disorder-pattern-recognition-study-of-brain-biomarkers/DCF85A7D69652C06E61524593B266E8C">Neuroimaging confirms structural differences</a> in the brains of people with dissociative identity disorder.</p>
<h2>A controversial diagnosis</h2>
<p>There are two competing theories about what causes dissociation: trauma and fantasy.</p>
<p>With the <a href="https://psycnet.apa.org/record/2012-06384-001">trauma model</a>, dissociative symptoms arise from physical, sexual and emotional abuse; neglect, particularly in childhood; attachment problems if a child fears the caregiver or the caregiver is not adequately attuned to the child’s emotional or safety needs; and other severe stress or trauma, such as experiencing or witnessing domestic violence. </p>
<p>This trauma model is reflected in the <a href="https://icd.who.int/en/">World Health Organisation</a> and <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">American Psychiatric Association</a> past and present diagnostic criteria.</p>
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Read more:
<a href="https://theconversation.com/a-soldier-and-a-sex-worker-walk-into-a-therapists-office-whos-more-likely-to-have-ptsd-71464">A soldier and a sex worker walk into a therapist’s office. Who's more likely to have PTSD?</a>
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<p>However, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24773505">fantasy model</a> is based on the idea that dissociative disorders are not “real”. Instead, they are the delusion of people who are troubled (and often traumatised), suggestible, fantasy-prone and sleep-deprived.</p>
<p>Fantasy model theorist <a href="https://www.cambridge.org/core/journals/bjpsych-advances/article/dissociative-identity-disorder-validity-and-use-in-the-criminal-justice-system/C1C27EE9731782570E1376A3EDA48CE4">Joel Paris</a> describes dissociative disorders as a North American “fad” that has nearly died out. </p>
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Read more:
<a href="https://theconversation.com/going-it-alone-adds-to-tertiary-students-high-mental-health-risk-41362">'Going it alone' adds to tertiary students' high mental health risk</a>
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<p>Yet <a href="https://www.researchgate.net/publication/334625332">my analysis of 98 studies</a> found rates are not declining. In fact, I found dissociation is an international phenomenon far more common in countries that are comparatively unsafe. This is supported by other research which finds dissociation more common in people that have experienced trauma, such as <a href="https://www.tandfonline.com/doi/abs/10.3109/08039488.2014.977344?src=recsys&journalCode=ipsc20">refugees</a>. </p>
<p>All up, the evidence indicates dissociative disorders are real (not imagined) and caused by trauma (not fantasy).</p>
<h2>Dissociative disorders are under-diagnosed and misdiagnosed</h2>
<p>Even though there are accurate ways of diagnosing dissociative disorders, most people will <a href="https://www.routledge.com/Humanising-Mental-Health-Care-in-Australia-A-Guide-to-Trauma-informed/Benjamin-Haliburn-King/p/book/9780367076603">never be diagnosed</a>. This is due to the lack of health professional education and training about dissociation, the symptoms being less obvious to observers, and scepticism that the disorder even exists. </p>
<p>The person also may not realise they have dissociative symptoms. Even if they do, they may not reveal them due to fear or embarrassment, or may find them difficult to put into words.</p>
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<a href="https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285439/original/file-20190724-110154-143qxv1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Misdiagnosis is common, as symptoms can overlap with ones commonly linked to other mental health issues.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-discussing-problems-counselor-384224875?src=-yuqkdmIX2ywDOabqmsqcA-1-43&studio=1">from www.shutterstock.com</a></span>
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<p>At least <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/assessment-of-the-prevalence-of-psychiatric-disorder-in-young-adults/5673B18071E22D850EF4E5F3241763FB">three-quarters of people with a dissociative disorder</a> will also have one or more other mental disorders. <a href="https://www.routledge.com/Humanising-Mental-Health-Care-in-Australia-A-Guide-to-Trauma-informed/Benjamin-Haliburn-King/p/book/9780367076603">They may be diagnosed with and treated for other mental health difficulties</a>, such as post-traumatic stress disorder, mood disorders, anxiety disorders, sleep disorders, borderline personality disorder, or psychosis. They may also be treated for addictions, self-harm, and/or suicidal thoughts (<a href="https://www.ncbi.nlm.nih.gov/pubmed/18195639">2% of those diagnosed complete suicide</a>). </p>
<p>They may also be misdiagnosed with schizophrenia because <a href="https://www.ncbi.nlm.nih.gov/pubmed/27209638">hearing voices is common to both</a>.</p>
<p>But their dissociative disorder usually remains undiagnosed. However, treatment for other mental health issues is not likely to be effective unless the underlying dissociation is addressed.</p>
<h2>How to treat? What does the evidence say works?</h2>
<p>The mental health and quality of life of people with a dissociative disorder <a href="https://psycnet.apa.org/record/2012-08580-001">improves</a> significantly with psychotherapy (a type of talk therapy) that recognises the impact of trauma <a href="https://besselvanderkolk.net/the-body-keeps-the-score.html">is physiological</a> (affecting the brain and body) as well as psychological.</p>
<p>In therapy consistent with international treatment <a href="https://www.tandfonline.com/doi/abs/10.1080/15299732.2011.537247">guidelines</a>, people can learn skills to cope with unbearable emotions, thoughts and physical sensations. Once people are stable and have constructive coping strategies, therapists can then help people process traumatic and dissociated memories. Dissociative, post-traumatic, and depressive <a href="https://psycnet.apa.org/record/2012-08580-001">symptoms improve</a>. And hospitalisations, self-harm, drug use, and physical pain declines.</p>
<p>There is no medication that specifically treats dissociation. </p>
<h2>Where to get help</h2>
<p>Dissociative disorders are one of the most common, yet most unrecognised, mental disorders. Symptoms are often debilitating, but significant improvements are possible if the dissociation is diagnosed and treated correctly. </p>
<p>If you are concerned, you can speak to your GP and ask for a referral to a therapist knowledgeable about trauma and dissociation. A list of therapists with this expertise in Australia is available from the <a href="https://www.blueknot.org.au/Helpline">Blue Knot Foundation</a> and worldwide from the <a href="https://isstd.connectedcommunity.org/network/network-find-a-professional">International Society for the Study of Trauma and Dissociation</a>.</p>
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<p><em>If this article has raised issues for you, or you’re concerned about someone you know, call Lifeline on 13 11 14 or the Blue Knot Helpline on 1300 657 380.</em></p><img src="https://counter.theconversation.com/content/116731/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary-Anne Kate received an Australian Postgraduate Award from theDepartment of Education and Training. She is affiliated with International Society for the Study of Trauma and Dissociation. </span></em></p>Dissociation occurs when a person experiences being disconnected from their memories, feelings, actions, thoughts, body and even their identity. And one in ten might be affected.Mary-Anne Kate, Adjunct Associate Lecturer, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/949712018-04-16T04:19:19Z2018-04-16T04:19:19ZMood and personality disorders are often misconceived: here’s what you need to know<p>With each new version of the widely-used manual of mental disorders, the number of mental health conditions increases. The latest version (<a href="https://www.psychiatry.org/psychiatrists/practice/dsm">DSM-5</a>) lists around 300 disorders. To complicate things, many share common features, such as depression and anxiety. </p>
<p>The manual is a useful guide for doctors and researchers, but making a diagnosis is not a precise science. So if the “experts” are still debating what’s what when it comes to categorising disorders, it’s not surprising misconceptions abound in the community about certain mental health conditions.</p>
<p>We learn about mental health conditions in a number of ways. Either we know someone who has experienced it, we’ve experienced it ourselves, read about it or seen something on TV. Movies and TV series commonly portray people with mental illness as dangerous, scary and unpredictable. The most popular (mis)representations are of characters with multiple personalities, personality disorders, schizophrenia and bipolar disorder.</p>
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<a href="https://theconversation.com/the-emotion-centre-is-the-oldest-part-of-the-human-brain-why-is-mood-so-important-63324">The emotion centre is the oldest part of the human brain: why is mood so important?</a>
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<p>While the media is an important source of information about mental illness, it can misinform the public if reported inaccurately, promoting stigma and perpetuating myths. And <a href="http://www.mindframe-media.info/for-media/reporting-mental-illness/evidence-and-research/evidence-about-mental-illness-in-the-media?a=6322">research shows</a> negative images of mental illness in the media (fictional and non-fictional) results in negative and inaccurate beliefs about mental illness. </p>
<h2>Dissociative identity disorder</h2>
<p>“Multiple personality disorder” or “split personality disorder” are colloquial terms for dissociative identity disorder. Despite being colloquially named a personality disorder, it’s actually a <em>dissociative</em> disorder. </p>
<p>A personality disorder is a long-term way of thinking, feeling and behaving that deviates from the expectations of culture. Whereas in dissociative identity disorder, at least two alternate personalities (alters) routinely take control of the individual’s behaviour. The individual is usually unable to remember what happened when an alter takes over: there are noticeble gaps in their memory, which can be extremely distressing. </p>
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Read more:
<a href="https://theconversation.com/dissociative-identity-disorder-exists-and-is-the-result-of-childhood-trauma-85076">Dissociative identity disorder exists and is the result of childhood trauma</a>
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<p>The popular TV series “The United States of Tara” actually does a pretty good job of portraying dissociative identity disorder. The main character has a series of alters and experiences recurrent gaps in her memory.</p>
<p>While it used to be considered rare, dissociative identity disorder is estimated to affect <a href="https://www.uptodate.com/contents/dissociative-identity-disorder-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis#H1244373">1% of the general population</a>, and is typically related to early trauma (such as childhood abuse). People commonly confuse dissociative identity disorder with schizophrenia. Unlike schizophrenia, the individual is not imagining external voices or experiencing visual hallucinations: one personality literally “checks out” and another appears in their place.</p>
<h2>Borderline personality disorder</h2>
<p>Borderline personality disorder is often misconstrued. People with this condition are often portrayed as manipulative, destructive and violent. In reality, these behaviours are driven by emotional pain: the person has never learned to ask effectively for what they need or want.</p>
<p>It is also often assumed “borderline” means the person <em>almost</em> has a personality disorder. The term “borderline” here creates some confusion. <a href="https://www.ncbi.nlm.nih.gov/books/NBK55415">First introduced in the United States in 1938</a>, the term was used by psychiatrists to describe patients who were thought to be on the “border” between diagnoses (mostly psychosis and neurosis). The term “borderline” has stuck in the diagnosis, but there is now a much better understanding of the causes, symptoms and treatment.</p>
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Read more:
<a href="https://theconversation.com/borderline-personality-disorder-is-a-hurtful-label-for-real-suffering-time-we-changed-it-41760">Borderline personality disorder is a hurtful label for real suffering – time we changed it</a>
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<p>Those with borderline personality disorder have difficulties regulating their emotions. This contributes to angry outbursts, anxiety and depression, and relationships fraught with difficulties. It’s also commonly associated with trauma (such as childhood abuse or neglect). </p>
<p>Many actions of a person with borderline personality disorder (such as self-harm and overdose) are done out of desperation in an attempt to manage difficult and intense emotions. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-borderline-personality-disorder-12523">Explainer: what is borderline personality disorder?</a>
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<h2>Bipolar disorder</h2>
<p>While borderline personality disorder and bipolar disorder can look similar (mood problems, impulsive behaviour and suicidal thinking), there are <a href="https://journals.lww.com/co-psychiatry/Citation/2014/01000/Clinical_differentiation_of_bipolar_II_disorder.4.aspx">several key differences</a>. </p>
<p>Bipolar disorder is characterised by extreme mood swings – from severe lows (depression) to periods of high activity, energy and euphoria. The different mood states can seem like a personality change, but a return to the “usual self” occurs once mood stabilises. </p>
<p>While depression is part of borderline personality disorder and bipolar disorder, those with bipolar disorder experience significant “up” mood swings. This is known as mania in bipolar I disorder and hypomania (less intense mania) in bipolar II disorder.</p>
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<a href="https://theconversation.com/explainer-what-is-bipolar-disorder-7502">Explainer: what is bipolar disorder?</a>
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<p>Bipolar mood episodes last longer (four days or longer for “ups” and two weeks or longer for “downs”), with periods of wellness in between, and are less likely to be triggered by external events. And bipolar disorder is more likely to run in families, disrupt sleep patterns, and psychotic symptoms (delusions, hallucinations) can occur during mood episodes.</p>
<p>We all have ups and downs, but bipolar disorder is much more than that with extreme, recurrent mood episodes that are not only distressing, but have a significant long-term impact on key areas of a persons’s life. Positively, with the right treatment, good quality of life is entirely possible despite ongoing symptoms.</p>
<h2>Schizophrenia</h2>
<p>Schizophrenia, meaning “split mind” in Greek, is often confused with dissociative identity disorder. However, the “split” refers not to multiple personalities, but to a “split” from reality. People with schizophrenia may find it difficult to discern whether their perceptions, thoughts, and emotions are based in reality or not. </p>
<p>Hearing voices (auditory hallucinations) is a common symptom, along with seeing, smelling, feeling, or tasting things others can’t. Unusual beliefs (delusions), including some that cannot possibly be true (such as a belief that one has special powers) are also common. So too is disordered thinking, where the person jumps from one topic to another at random, or makes strange associations to things that don’t make sense. They may also exhibit bizarre behaviour including socially inappropriate outbursts or wearing odd clothing that is inappropriate to the circumstances.</p>
<p>Other symptoms of schizophrenia look a lot like depression, such as an inability to experience pleasure, social withdrawal and low motivation. Depressive symptoms are also present in schizophrenia, but are slightly different in that emotion is diminished altogether, rather than a depressed mood per se.</p>
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Read more:
<a href="https://theconversation.com/either-mad-and-bad-or-jekyll-and-hyde-media-portrayals-of-schizophrenia-12391">Either mad and bad or Jekyll and Hyde: media portrayals of schizophrenia</a>
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<h2>Mental health conditions don’t come in neat packages</h2>
<p>Unlike physical conditions, we don’t have a biological test that can magically tell us what mental condition we’re dealing with. Mental health practitioners are carefully trained to observe symptom patterns: the right diagnosis guides the appropriate treatment. </p>
<p>For example, first-line treatment of schizophrenia and bipolar disorder often focuses on medication. While dissociative identity disorder and borderline personality disorders are treated primarily with psychological therapy. </p>
<p>Mental health conditions are serious – whether disorders of personality, mood or somewhere in between. Improved understanding and balanced representation of these conditions is needed to shift stigmas and misconceptions in the community.</p><img src="https://counter.theconversation.com/content/94971/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Media portrayals don’t help misconceptions about disorders such as bipolar, schizophrenia and borderline personality disorder. So what do these terms actually mean?Kathryn Fletcher, Postdoctoral Research Fellow, Swinburne University of TechnologyKristi-Ann Villagonzalo, Postdoctoral Research Fellow, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/850762017-10-04T19:12:16Z2017-10-04T19:12:16ZDissociative identity disorder exists and is the result of childhood trauma<figure><img src="https://images.theconversation.com/files/188709/original/file-20171004-6713-od2fk2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dissociative identity disorder is a serious and valid mental illness.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/arul72/19735860332/in/photolist-w4ZrG1-4QPNfe-ET5NFR-9KqDMk-tPUG38-Has64J-UWtRqK-j1wTKc-34o6Ta-T29frB-6eUke3-t36W2z-6pn2hE-qeD2iH-6qv3b4-ocPiUt-58uX9W-qDBPCe-YgPM2H-9mtAak-87bzEp-4vZxLY-5w493M-4LZXAd-jihguK-roCJtM-7HT4fS-78EkHk-99MvpM-mjryAM-7PG2KJ-oHsCoQ-4HFpvK-7etH5D-29kmfN-7jxy2h-576Udw-5nvx57-5mbAdP-5F3aPy-93Hpt7-q6Ud7x-6CGJ5e-aEG8Tr-9sATy9-hNrARK-cymJmQ-pAfTU4-RFqUMR-zfRED2">Irudayam/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Once known as multiple personality disorder, dissociative identity disorder remains one of the most intriguing but poorly understood mental illnesses. <a href="https://www.researchgate.net/profile/Richard_Loewenstein/publication/279040156_Dissociative_disorders_in_DSM5DMS_vol_28_pg_E17_2011/links/558ad30b08ae48b7b56d978d/Dissociative-disorders-in-DSM5DMS-vol-28-pg-E17-2011.pdf">Research</a> and <a href="http://www.tandfonline.com/doi/abs/10.3109/00048679809073868">clinical experience</a> indicate people diagnosed with the condition have been victims of sexual abuse or other forms of criminal mistreatment. </p>
<p>But a vocal group of academics and health professionals have claimed dissociative identity disorder, and reports of trauma associated with it, are created by therapists and the media. They say these <a href="http://www.leadershipcouncil.orgwww.leadershipcouncil.org/docs/gleaves2001.pdf">don’t reflect genuine symptoms or accurate memories</a>. </p>
<p>Media references to dissociative identity disorder are also often highly stigmatising. The recent movie Split depicted a person with the condition as a <a href="http://edition.cnn.com/2017/01/23/health/shyamalan-split-movie-dissociative-identity-disorder/index.html">psychopathic murderer</a>. Even supposedly factual reporting can present people with dissociative identity disorder as untrustworthy and prone to wild fantasies and <a href="http://www.theaustralian.com.au/life/weekend-australian-magazine/unbelievers-coach-some-family-say-sadistic-father-is-innocent/news-story/4da672cae6eca0548ef389f655745e81">false memories</a>. </p>
<p>But research hasn’t found people with the disorder are more prone to “false memories” <a href="https://www.researchgate.net/profile/Bethany_Brand/publication/303536752_Is_it_Trauma-_or_Fantasy-based_Comparing_dissociative_identity_disorder_post-traumatic_stress_disorder_simulators_and_controls/links/5747a44908aef66a78b07f1c.pdf">than others</a>. And brain imaging studies show <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0039279">significant differences in brain activity</a> between people with dissociative identity disorder and other groups, including those who have been trained to mimic the disorder.</p>
<h2>What is it?</h2>
<p>Dissociative identity disorder has been studied by doctors and scientists for well over 100 years. In 1980, it was called <a href="https://www.healio.com/psychiatry/journals/psycann/1984-1-14-1/%7B3bc95d4a-5e6a-4561-b6aa-3b5b623ef0af%7D/an-introduction-to-multiple-personality-disorder">multiple personality disorder</a> in the <a href="https://theconversation.com/explainer-what-is-the-dsm-and-how-are-mental-disorders-diagnosed-9568">Diagnostic and Statistical Manual of Mental Disorders</a> (DSM), which outlines the symptoms of psychiatric conditions. Its name was changed in the 1994 edition of the DSM. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-the-dsm-and-how-are-mental-disorders-diagnosed-9568">Explainer: what is the DSM and how are mental disorders diagnosed?</a>
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<p>Dissociative identity disorder comes about when a child’s psychological development is disrupted by early repetitive trauma that prevents the normal processes of consolidating a <a href="https://www.researchgate.net/profile/Bethany_Brand/publication/271770028_Dissociative_identity_disorder/links/54d17b8f0cf28959aa7b0a64/Dissociative-identity-disorder.pdf">core sense of identity</a>. <a href="http://checkedinbatesmotel.com/wp-content/uploads/2015/05/Objective_Documentation_of_Child_Abuse_and_Dissociation_in_12_Murderers.pdf">Reports of childhood trauma</a> in people with dissociative identity disorder (that have been substantiated) include burning, mutilation and exploitation. <a href="https://www.researchgate.net/profile/Warwick_Middleton/publication/13207407_Dissociative_Identity_Disorder_An_Australian_Series/links/02bfe5114d22f20fc4000000.pdf">Sexual abuse</a> is also routinely reported, alongside emotional abuse and neglect. </p>
<p>In response to overwhelming trauma, the child develops multiple, often conflicting, states or identities. These mirror the radical contradictions in their early attachments and social and family environments – for instance, a parent who swings unpredictably between aggression and care. </p>
<p>According to the DSM-5, the <a href="https://www.healthyplace.com/abuse/dissociative-identity-disorder/dissociative-identity-disorder-did-dsm-5-criteria/">major characteristic of dissociative identity disorder</a> is a disruption of identity, in which a person experiences two or more distinct personality states (or, in other cultures, experiences of so-called <a href="http://www.tandfonline.com/doi/abs/10.1080/15299732.2011.573762">possession</a>).</p>
<p>These states display marked differences in a person’s behaviour, recollections and opinions, and ways of engaging with the world and other people. The person frequently experiences gaps in memory or difficulties recalling events that occurred while they were in other personality states. </p>
<p>The manifestations of these symptoms are <a href="https://insights.ovid.com/psychiatric-annals/psann/2005/08/000/diagnosing-dissociative-identity-disorder/8/00011075">subtle and well concealed</a> for most patients. However, overt symptoms tend to surface during times of stress, re-traumatisation or loss. </p>
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<a href="https://images.theconversation.com/files/188711/original/file-20171004-6700-jjnggy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/188711/original/file-20171004-6700-jjnggy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/188711/original/file-20171004-6700-jjnggy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188711/original/file-20171004-6700-jjnggy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188711/original/file-20171004-6700-jjnggy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188711/original/file-20171004-6700-jjnggy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188711/original/file-20171004-6700-jjnggy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188711/original/file-20171004-6700-jjnggy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Media references to dissociative identity disorder, like the lead character in the movie Split, are often highly stigmatising.</span>
<span class="attribution"><a class="source" href="http://www.imdb.com/title/tt4972582/mediaviewer/rm2852981248">Blinding Edge Pictures Blumhouse Productions Dentsu (in association with) Fuji Eight Company Ltd/IMDb</a></span>
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<p>People with the condition typically have a number of other problems. These include depression, self-harm, anxiety, suicidal thoughts, and increased susceptibility to physical illness. They frequently have difficulties engaging in daily life, including employment and interactions with family. </p>
<p>This is, perhaps, unsurprising, given people with dissociative identity disorder have <a href="https://www.researchgate.net/profile/Richard_Loewenstein/publication/279040156_Dissociative_disorders_in_DSM5DMS_vol_28_pg_E17_2011/links/558ad30b08ae48b7b56d978d/Dissociative-disorders-in-DSM5DMS-vol-28-pg-E17-2011.pdf">experienced more trauma</a> than any other group of patients with psychiatric difficulties. </p>
<p>Dissociative identity disorder is a relatively common psychiatric disorder. <a href="https://www.researchgate.net/profile/Richard_Loewenstein/publication/279040156_Dissociative_disorders_in_DSM5DMS_vol_28_pg_E17_2011/links/558ad30b08ae48b7b56d978d/Dissociative-disorders-in-DSM5DMS-vol-28-pg-E17-2011.pdf">Research in multiple countries</a> has found it occurs in around 1% of the general population, and in up to one fifth of patients in inpatient and outpatient treatment programs. </p>
<h2>Trauma and dissociation</h2>
<p>The link between severe early trauma and dissociative identity has been controversial. Some clinicians have proposed dissociative identity disorder is the result of <a href="https://www.researchgate.net/profile/Bethany_Brand/publication/221695375_Evaluation_of_the_Evidence_for_the_Trauma_and_Fantasy_Models_of_Dissociation/links/0a85e530bc56d0cab1000000.pdf">fantasy and suggestibility</a> rather than abuse and trauma. But the <a href="https://www.towson.edu/cla/departments/psychology/facultystaff/dalenbergetalevalevidencefortraumaandfantasymodelspsychbull2012.pdf">causal relationship between trauma and dissociation</a> (alterations of identity and memory) has been repeatedly shown in a range of studies using different methodologies across cultures. </p>
<p>People with dissociative identity disorder are generally unresponsive to (and may deteriorate under) <a href="https://www.researchgate.net/profile/Bethany_Brand/publication/271770028_Dissociative_identity_disorder/links/54d17b8f0cf28959aa7b0a64/Dissociative-identity-disorder.pdf">standard treatment</a>. This may include cognitive behavioural treatment, or exposure therapy for post-traumatic stress disorder.</p>
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<p><strong><em>Read more</em></strong>: </p>
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<li><p><strong><em><a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">What is cognitive behaviour therapy?</a></em></strong></p></li>
<li><p><strong><em><a href="https://theconversation.com/explainer-what-is-exposure-therapy-and-how-can-it-treat-social-anxiety-64483">What is exposure therapy and how can it treat social anxiety?</a></em></strong></p></li>
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<p>Phase-orientated treatment <a href="https://www.researchgate.net/publication/26810629_A_Review_of_Dissociative_Disorders_Treatment_Studies">has been shown to improve</a> dissociative identity disorder. This <a href="http://www.isst-d.org/downloads/guidelines_revised2011.pdf">involves stages (or phases) of treatment</a>, from an initial focus on safety and stabilisation, through to containment and processing of trauma memories and feelings, to the final phase of integration and rehabilitation. The goal of treatment is for the person to move towards better engaging in life without debilitating symptoms. </p>
<p>An international study that followed 280 patients with dissociative identity disorder (or a variant of it, which is a <a href="https://psychcentral.com/disorders/dissociative-disorder-not-otherwise-specified-nos/">dissociative disorder not otherwise specified</a>) and 292 therapists over time, found this approach was associated with improvements across <a href="https://www.researchgate.net/publication/230663668_A_Longitudinal_Naturalistic_Study_of_Patients_With_Dissociative_Disorders_Treated_by_Community_Clinicians">a number of psychological and social functioning</a> areas. Patients and therapists reported reduction in dissociation, general distress, depression, self-harm and suicidal thoughts.</p>
<h2>Controversies and debates</h2>
<p>Critics have pointed to poor therapeutic practice causing dissociative symptoms as well as false memories and false allegations of abuse. Some are particularly concerned therapists are focused on recovering memories, or encouraging patients to speculate that they have been abused.</p>
<p>However, a <a href="https://www.researchgate.net/publication/230663660_A_Survey_of_Practices_and_Recommended_Treatment_Interventions_Among_Expert_Therapists_Treating_Patients_With_Dissociative_Identity_Disorder_and_Dissociative_Disorder_Not_Otherwise_Specified">contemporary survey of clinical practice</a> among specialists of dissociative identity found those treating the disorder weren’t focused on retrieving memories at any phase of the treatment.</p>
<p>A <a href="https://www.researchgate.net/profile/Bethany_Brand/publication/262682220_Dispelling_Myths_About_Dissociative_Identity_Disorder_Treatment_An_Empirically_Based_Approach/links/0a85e538cb428ee6c2000000/Dispelling-Myths-About-Dissociative-Identity-Disorder-Treatment-An-Empirically-Based-Approach.pdf">recent literature analysis</a> concluded that criticisms of dissociative identity disorder treatment are based on inaccurate assumptions about clinical practice, misunderstandings of symptoms, and an over-reliance on anecdotes and unfounded claims. </p>
<p>Dissociative identity disorder treatment is frequently unavailable in the <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Former_Committees/mentalhealth/report/c05">public health system</a>. This means people with the condition remain at high risk of ongoing illness, disability and re-victimisation. </p>
<p>The underlying cause of the disorder, which is severe trauma, has been largely overlooked, with little discussion of the prevention or early identification of extreme abuse. Future research should not only address treatment outcomes, but also focus on public policy around prevention and detection of extreme trauma. </p>
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<p><em>If this article has raised concerns for you or anyone you know, call Lifeline 13 11 14, Suicide Call Back Service 1300 659 467 or Kids Helpline 1800 55 1800.</em></p><img src="https://counter.theconversation.com/content/85076/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Michael Salter is affiliated with the International Society for the Study of Trauma and Dissociation. </span></em></p><p class="fine-print"><em><span>Martin Dorahy is affiliated with the International Society for the Study of Trauma and Dissociation </span></em></p><p class="fine-print"><em><span>Adjunct Professor Warwick Middleton is affiliated with the International Society for the Study of Trauma and Dissociation.
</span></em></p>Dissociative identity disorder - previously known as multiple personality disorder - occurs when a child’s development is disrupted by trauma, preventing them forming a strong sense of self.Michael Salter, Senior Lecturer in Criminology, Western Sydney UniversityMartin Dorahy, Professor of Clinical Psychology, University of CanterburyWarwick Middleton, Adjunct Professor, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.